Long Term Care Medicaid vs Worker's Comp Case Management

[cubrnjvm, MSN, RN]

Hello All!!

I have a dilemma and would like your help, I have read many topics and threads but have not been able to figure things out. I'm looking at two choices, one is with an insurance company worker's comp and the other one Long term care Medicaid, both are field case management, benefits are pretty good, even though money shows a little difference (more on the Medicaid one) I don't want to apply based on just money, I would like the feedback from some of you that work (worked) on any of these. I would like to know if the fact that you have to attend doctor's appointments with the injured will make a huge difference on what your working time is, what about patient advocacy and care? whatever your input, I will really appreciate that.

[nurseprnRN, BSN, RN]

I'd take the work comp in a heartbeat. You may have patients that will make you nuts, but you won't have them forever, and you don't have the hopelessness and lack of resources you have to fight with the Medicaid population. Plus you have a lot more ability to schedule MD patient appointments for your own convenience, you learn where all the good sales are when you drive around, and you can meet a lot of really good docs and learn a TON. I did this for many years and just lovedlovedloved it.

You will attend MD appts with a lot of your patients, but not all-- if they are lawyered up, the attys generally refuse your the ability to meet or speak with the patients at all. You can still follow them through good communication c the treating team, though.

There is definitely great opportunity to act as a patient advocate. While the insurance carrier is hiring you to try to save them money, as a nurse you know quite well that skimping on or denying definitive care early on post injury is a really good way to be sure it will cost you a lot more later. I used to tell the adjusters that they paid me for my opinion and they could do what they wanted with it, but if they were smart they'd listen to me; over time, the smart ones did. :)

I got them to pay for acupuncture for one guy who had failed traditional pain mgmt-- he got so much better he went back to his old job with joy.

I got a number of MRIs done earlier than the algorithms specified for patients who were so convinced that they had terrible injuries that they wouldn't participate in the PT that would make them better, and the delay until the MRI would meet criteria would make them worse; when they knew they had a painful-but-not-dangerous condition, they were much better able to participate in rehab.

In the state where I did a lot of this the reimbursement rate for physicians was ridiculously low so many of the good docs wouldn't accept WC patients, leaving the bottom-feeders to abuse the system (and not do good treatment, either..). I talked the adjusters into negotiating rates with the good docs I had learned would really be helpful and get people back to work safely and quickly-- paying more for a few MD visits and good therapy was a lot less than paying temporary partial disability, and certainly less than paying permanent and total.

I found the whole thing fascinating, liked the problem-solving bits, loved almost all of the patients, and really, really loved the autonomy. That's my story. :)

[cubrnjvm, MSN, RN]

Thank you!!! I have been trying to get in touch with you because I have read your posts!!! thank you!!! I will definitively take in consideration your opinion, will it matter to you they are offering less than the LTC Mcaid?

[Bear05]

This is a good question that I've been wanting to know as well. How difficult is it to learn workers comp without previous case management experience?

[nurseprnRN, BSN, RN]

Thank you!!! I have been trying to get in touch with you because I have read your posts!!! thank you!!! I will definitively take in consideration your opinion, will it matter to you they are offering less than the LTC Mcaid?

You can PM me prn. However, as I am fond of saying, there are things more important than money. For me, the ability to (largely) schedule my own time and work load and a great deal of autonomy is worth a good bit. Also,my field case management jobs paid mileage at the current IRS rate (because I was required to use my own car), and I drove so much on one of them that my monthly mileage reimbursement was more than my car payment. :) AND I got to listen to NPR and books on tape while I did it, which was almost recreational.

How difficult is it to learn workers comp without previous case management experience?

No more so than learning anything else new. They pair you up with people who are good at it, give you the tools to use, and see how you progress on the novice-to-expert continuum. I think it's great to learn an entirely different specialty to use your nursing knowledge every decade or so. :)